Challenges in Using MCDA for Reimbursement Decisions on New Medicines?

Multicriteria decision analysis (MCDA) is attracting considerable interest as a tool to assist decision makers faced with the challenge of considering a range of relevant factors when making their decision. The Scottish Medicines Consortium (SMC) is a long-established national health technology assessment (HTA) agency providing guidance to the health service on all new medicines. The stated criterion includes clinical effectiveness and cost-effectiveness but allows other factors to play a role. “Cost per quality-adjusted life-year (QALY)” is important but is not the only factor—if it were, as one SMC Chairman remarked, the committee could just chat over lunch while the economists made the decisions. What might the SMC make of the ISPOR Task Force report on emerging good practice in MCDA? The starting point would be to consider what MCDA is. The report refers to “methods that help deliberative discussions using explicitly defined criteria, but without quantitative modeling.” How does the SMC include other factors now? There are three possibilities.